Bipolar Disorder Is Different for Women

Diagnosing bipolar disorder is a notoriously inexact science. The disorder’s characteristic combination of symptoms—bouts of depression interspersed with periods of an abnormally elevated mood known as mania—is easy to miss or misread, even for trained experts. People with bipolar disorder, who often receive an initial diagnosis of unipolar (or major) depression, can struggle with their symptoms for years before the disorder is recognized and treated. By some estimates, as many as half of all bipolar cases are not identified.

Women with bipolar disorder may be especially susceptible to misdiagnosis. A recent study estimated that the odds that a woman with bipolar disorder will fail to be correctly diagnosed are roughly three times the odds for a man. This disparity may be explained in part by the fact that bipolar disorder tends to look different in women than it does in men—in the same way that physicians sometimes fail to catch heart disease in women because they are effectively looking for the male version of the disease, mental health professionals may not always be aware of the distinctive signs of bipolar disorder in women.

"Women are more demonstrative—they have more of what’s known as 'affective loading'—so it's not surprising that bipolar disorder might be underdiagnosed in women compared to men," says Vivien Burt, MD, PhD, director of the Women’s Life Center at UCLA’s Resnick Neuropsychiatric Hospital.

Less intense manic phases
Jil, a 29-year-old from Mississippi, first experienced symptoms of bipolar disorder (depressed mood, insomnia, excess energy) in high school. When she was 16, her doctor diagnosed her with major depression and prescribed the antidepressant sertraline (then known by its brand name, Zoloft). The medication made Jil "completely manic"—which antidepressants are believed to do in some people with bipolar disorder—and a year later, a different doctor finally diagnosed her as bipolar.

"I've always had more severe depression than mania," Jil explains. "My depression is debilitating. When I’m manic I don’t sleep and sometimes spend money when I know I shouldn’t, but mainly I am very productive and mean as a hornet. I used to cycle rapidly, but medications have slowed things down a lot, so I don’t have ups and downs as frequently as I did before."

Compared to the average woman with bipolar disorder, Jil’s experience is unusual in some ways. The age at which she was diagnosed, for instance: Most people with bipolar disorder have their first manic episodes in their 20s or 30s, and research suggests that women tend to develop symptoms of the disorder three to five years later than men, on average.